Mai and coworkers recently reported a case of BP triggered by thermal burn in a patient treated with a DPP4i, which became generalized and relapsed after a few months, despite drug suspension . BP can arise on sites of surgical procedures, such as surgical wounds [31,109,119,120], skin graft [31,121,122,123], and ostomy [31,109,124,125]. by DIF. 2.4. Physical Factors Triggering or exacerbation of BP has been reported after exposure to a variety of physical factors. Involved agents include injuries such as trauma, surgical interventions, thermal or electric burns, ultraviolet (UV) exposure, radiotherapy (RT) and, more recently, photodynamic therapy. Despite the frequent clinical and empirical observation of this relationship, reports are often anecdotal and large epidemiological data are lacking. Mai and coworkers, in a recent review, identified 147 published cases of BP triggered by external factors. Most commonly reported triggering factors in BP are: RT (25.4%), UV (25.1%), surgical procedures (37%), thermal or chemical burns (9.5%). Other factors (scratching, mechanical trauma, insect bite, dye injection) have been occasionally reported . The association between BP and radiotherapy has been widely described [68,108,109,110]. Hung and coworkers recently published a case-control study on female patients with autoimmune bullous diseases (BP and PV). They found that a medical history of RT or breast cancer was associated with a higher risk to develop BP or PV . A review by Nguyen and coworkers reported GNE 477 29 published cases Rabbit polyclonal to MBD3 of BP provoked by radiotherapy; 86% of them were women, among whom 84% had breast cancer; 72% developed BP after RT (mean time of onset 15.8 months, median 5 months, range 2 weeksC5 months), while in 28%, BP arose during the RT cycle. The mean dose of inducing RT was 27.7 GY (range 20C46). At onset, the disease involved area of irradiation in 93% of patients and, subsequently, became generalized in 41% . RT has been reported to trigger BP in association with anti-PD1 antibody nivolumab [112,113,114]. Several cases of BP triggered by thermal or chemical burns have been described [31,115,116,117,118]. In these cases, disease usually remains localized, has a favorable clinical course and rarely relapses. Mai and coworkers recently reported a case of BP triggered by thermal burn in a patient treated with a DPP4i, which became generalized and relapsed after a few months, despite GNE 477 drug suspension . BP can arise on sites of surgical procedures, such as surgical wounds [31,109,119,120], skin graft [31,121,122,123], and ostomy [31,109,124,125]. The onset of BP on old scars has been reported . BP can be induced by UV or phototherapy (mainly psoralen and ultraviolet A or ultraviolet B therapy) for other dermatologic diseases, usually psoriasis or Micosis fungoides [31,109,127,128,129,130]. Psoriatic patients are at higher risk for BP . Even if the exact etiopathogenesis underlying this association is still not clear, it has been hypothesized that a role of abnormal psoriatic BMZ triggers BP [131,132,133]. As BP lesions usually appear on preexisting psoriatic lesions, it has been postulated that this mechanism could be triggered by antigenic changes induced by UVB and PUVA on psoriatic skin [134,135]. Photodynamic therapy, a technique utilized mainly for the treatment of no-melanoma skin cancers, has been indicated as a possible trigger factor in a small number of cases [136,137]. Overall data suggest that patients with BP induced by physical factors have a lower mean age and are predominantly females . Disease can become generalized or remain localized to the site of injury. Despite the fact that the majority of cases of the disease arises after a time interval, varying from 1 month to 1 1 year from first exposure to triggering agent, onset can occur after GNE 477 several years . In described.
Mai and coworkers recently reported a case of BP triggered by thermal burn in a patient treated with a DPP4i, which became generalized and relapsed after a few months, despite drug suspension